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Showing results for tags 'Accident and Emergency'.
Found 434 results
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News Article
‘Constructive’ first ambulance strike agreement revealed
Patient Safety Learning posted a news article in News
Elderly people who fall may only be sent an ambulance after they have spent four hours on the floor, and some category 2 calls may not be responded to under one of the first agreements with ambulance unions about next week’s strikes. But the deal between South East Coast Ambulance Service and the GMB union will see many union staff continue to work on ambulances and in control rooms – and others may be asked to come off the picket line if operational pressures escalate. HSJ has seen the details of the deal – thought to be one of the first agreed before next Wednesday’s strike. Some other trusts are hoping to conclude negotiations shortly, but for several — such as in the North West and London — it is thought no strike “derogations” (exceptions) have so far been agreed, and managers are concerned that unions are resistant. Trusts have been pushing for more cover on strike days – especially around category 2 calls. Read full story (paywalled) Source: HSJ, 15 December 2022 -
News Article
Every ambulance trust on highest alert level
Patient Safety Learning posted a news article in News
All ambulance services have declared the highest level of alert due to ‘extreme pressures’ facing the urgent and emergency care system. One senior ambulance chief told HSJ that ambulance response times have dropped dramatically in the last few days, while A&E handover delays have surged. They said: “The wheels are falling off [the emergency care system] now, we’re in a really awful situation.” They said ambulance leaders have major concerns about the planned strike action by nurses on Thursday, fearing this will exacerbate discharge delays and have a knock-on effect on ambulance handover problems. It also comes ahead of strike action planned by ambulance staff for next week. HSJ has seen internal communications which confirm all ten ambulance trusts in England are now in level four of their “resource escalation action plan”, which means they can seek assistance from other nearby trusts or services. However, this is more difficult when an entire sector is under pressure, as is the case currently. Read full story (paywalled) Source: HSJ, 13 December 2022 -
News ArticleBosses at the North West Ambulance Service issued an urgent warning to members of the public on 999 calls and apologised for delays last night. At 5pm on Monday (December 12), more than 600 patients were waiting for an ambulance across the North West, the service said. Another 100 emergency vehicles were parked outside of hospitals waiting to handover patients. 'Severe weather and hospital handover delays' had an impact on the service last night, as well as 'significant demand'. Ambulance chiefs said they had to 'maximise resources' by putting all clinically-trained staff on the frontline and increasing use of private providers. In an urgent message issued on Monday night, medical director Dr Chris Grant said: "This is an urgent message for the public across the whole of the North West. Tonight, across both our 111 and 999 services, we're seeing a really significant demand and I apologise for the delay in getting care to you but I do need your help. "We've called in all our operational and clinical resources to make sure we prioritise those who have the most life-threatening conditions. We need to keep our phone lines free so please only call us back if you no longer need our help or if your own condition has got significantly worse. Thanks for your support." Ged Blezard, director of operations at NWAS said: "Please only call 999 if someone has a serious illness or injury, you think their life is at risk, and you cannot get them to hospital by any other means. We know there are patients waiting for our help and we are sorry that we are unable to respond as quickly as we would like. Read full story Source: Manchester Evening News, 13 December 2022
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News ArticleOne in five cases in which patients attend A&E needing mental healthcare are spending more than 12 hours in the department – at least double the rate of patients with physical health problems. Unpublished internal NHS data seen by HSJ also suggests the proportion of mental health patients suffering long waits in accident and emergency has almost tripled when compared to the situation before the pandemic. According to the data, the proportion of attendances by patients with a mental health problem who waited more than 12 hours in A&E before being admitted or discharged increased from 7% (34,945 breaches) in 2019-20 to 20% (88,250 breaches) in 2022-23. The situation has become so difficult, that some acute trusts are spot purchasing private sector mental health in order to discharge patients. Read full story (paywalled) Source: HSJ, 5 June 2023
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News ArticleAbout 23,000 people died in accident and emergency departments last year, according to an estimate by Labour based on Freedom of Information requests to every NHS trust in England. Half of the trusts responded to the party’s requests and, based on that information, it calculated that just over 23,000 people had died – an increase of more than 20% on 2021, and nearly 40% on 2020. The increase in deaths corresponds with a sharp rise in NHS waiting times, as hospitals struggle with high demand and a lack of resources after the Covid-19 pandemic. Wes Streeting, the shadow health secretary, said: “People turning to the NHS in an emergency should know they will be seen and treated before it’s too late. The Conservatives’ failure over 13 years to properly staff or reform the NHS has a cost in lives.” Maria Caulfield, the health minister, defended the government’s record, however, saying: “We are delivering a record number of tests, speeding up discharge from hospitals, and cutting waiting lists as we also work to halve inflation, grow the economy, reduce debt, and stop the boats.” Read full story Source: The Guardian, 19 May 2023
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News Article
'Multiple systemic failures' found at Royal Infirmary of Edinburgh A&E
Patient Safety Learning posted a news article in News
Patients spent up to 25 hours on trolleys in corridors waiting for treatment and in some cases were left lying on "urine-soaked sheets" and in another on a "blood-stained pillow for several hours" at the Royal Infirmary of Edinburgh. Healthcare Improvement Scotland (HIS) inspectors also raised concerns over fire safety in the overcrowded A&E after two visits to the hospital - the first of which was carried out between February 20 to 22 and a further unannounced follow-up in March. The watchdog found "multiple systemic failures" in a report published on Thursday but NHS Lothian said a major improvement drive was already underway. The health board added that the hospital was had just endured its busiest winter on record ahead of the inspections. At the time of the inspection, the emergency department was on some days operating at over three times its capacity. The report described this as unsafe and a "fire safety risk" with the evacuation plan in place at the time not reflecting the "significant" impact of overcrowding. Read full story Source: The Herald, 18 May 2023 -
News Article
Trust’s A&E ‘effectively running primary care service’, says chair
Patient Safety Learning posted a news article in News
An acute trust chair has said its emergency department is effectively operating as a primary care service. Hattie Llewelyn-Davies, who has chaired The Princess Alexandra Hospital Trust since late 2021, told HSJ: “We’ve done an awful lot of changes in the way we run out A&E and same day emergency care service to try and get the flow through working better… “We have particular problems with the Princess Alexandra because we are right in the middle of Harlow. And we have a GP service and primary care service which is under massive pressure. We have very high levels of deprivation in Harlow. “When somebody is sick in Harlow and can’t get a doctor’s appointment on the spot, they walk into us. We have a very high level of people coming in, so a very high level of footfall but a very low level of admissions. “We are therefore running effectively a primary care service through our A&E.” Read full story (paywalled) Source: HSJ, 15 May 2023 -
News Article
‘One nurse per ward’ warning over next week’s strike
Patient Safety Learning posted a news article in News
A major acute trust has warned ahead of next week’s nursing strike that it will face ‘very severe staffing shortages’ in children’s A&E, with ‘as few as one nurse per ward’, much less critical care capacity, and fewer operating theatres open than on Christmas Day. Cambridge University Hospitals Foundation Trust’s medical director said in a note, seen by HSJ, that the hospital would only have 60 to 70% of its critical care beds open and that “it is not possible to guarantee patient safety on our wards over the forthcoming weekend” with severe staffing shortages in “almost all areas”. The Royal College of Nursing is planning no derogations (exceptions) to its planned 48-hour walkout, from 8pm on Sunday until 8pm on Tuesday, whereas its previous action has exempted emergency care. There have been national warnings about the significant safety threat posed, but the CUH message, sent to all staff by medical director Ashley Shaw, sets out a more stark picture of critical services scaled back. It says: ”Our current information indicates there will be a severe shortage of nurses in almost all ward areas, with as few as 1 nurse per ward per shift." Read full story (paywalled) Source: HSJ, 26 April 2023 -
News Article
One in 10 A&E patients waits 12hrs, long-hidden data reveals
Patient Safety Learning posted a news article in News
Around 10 per cent of the 1.2 million accident and emergency attendees in February waited 12 hours or more, newly published NHS England data has revealed, laying bare the true extent of the NHS’s emergency care crisis. The data – which NHSE has collected for years but has only now started to publish – shows 125,505 patients waited 12 hours or more from their arrival at A&E to be admitted, transferred or discharged. This is more than double the highest figure under the existing metric of around 55,000, which only starts the clock from when the patient has received a decision to admit. NHSE’s decision to publish the data for 12-hour breaches from time of arrival follows a concerted campaign by the Royal College of Emergency Medicine, which has long raised concerns the measure from decision to admit has significantly masked the true extent of long waits in A&E. Read full story (paywalled) Source: HSJ, 13 April 2023 -
News Article
A&E staff in England struggling to spot abuse cases in infants, says watchdog
Patient Safety Learning posted a news article in News
Staff in hospital emergency departments in England are struggling to spot when infants are being physically abused by their parents, raising the risk of further harm, an investigation has found. Clinicians often do not know what to do if they are concerned that a child’s injuries are not accidental because there is no guidance, according to a report from the Healthcare Safety Investigation Branch (HSIB) that identifies several barriers to child safeguarding in emergency departments. Matt Mansbridge, a national investigator, said the report drew on case studies of three children who were abused by their parents, which he said were a “hard read” and a “stark reminder” of the importance of diagnosing non-accidental injuries quickly, since these are the warning sign in nearly a third of child protection cases for infants under the age of one. “For staff, these situations are fraught with complexity and exacerbated by the extreme pressure currently felt in emergency departments across the country,” Mansbridge said. He said the clinicians interviewed wanted to “see improvement and feel empowered” to ask difficult questions. “The evidence from our investigation echoes what staff and national leads told us – that emergency department staff should have access to all the relevant information about the child, their history and their level of risk, and that safeguarding support needs to be consistent and timely/ Gaps in information and long waits for advice will only create further barriers to care,” he said. Read full story Source: The Guardian, 13 April 2023 -
News Article
Hull A&E is a 'death trap', whistleblowers warn
Patient Safety Learning posted a news article in News
Whistleblowers have described the accident and emergency (A&E) department at Hull Royal Infirmary as "incredibly dangerous" and a "death trap". The Care Quality Commission (CSC) found Hull University Teaching Hospitals required improvement overall and its A&E department was rated inadequate. Two clinical staff members, who wished to remain anonymous, described it as a "toxic" place to work. Speaking to the BBC, the two staff members who have worked in Hull's A&E department said they had raised concerns with senior managers and the CQC. They said there were frequently fewer staff than needed and warned inexperienced staff, one whom had never seen a cardiac arrest, were working in areas like resuscitation, which was "incredibly dangerous". "Nurses who aren't even signed off to give oral medication are being put in resuscitation," one said. "It's a death trap, it is terrifying." Despite these concerns, CQC inspectors in December and November did find the service "had enough nursing and support staff to keep patients safe". Read full story Source: BBC News, 28 March 2023 -
News Article
Stretched A&E staff ‘rarely saw exec team’, review finds
Patient Safety Learning posted a news article in News
Trust executives and senior managers have been criticised by a former national director for their lack of support for an under-pressure A&E. An independent review described York Hospital as “reluctant” to trigger internal escalation processes, and suggested it should be quicker to admit extra patients to inpatient wards during busy periods. Professor Matthew Cooke, a former national clinical director for emergency care who conducted the review, said that during his two-day visit to the department he witnessed a 60-hour delay for a patient to be admitted: “I was surprised not to see any senior managers or executives in the ED, despite such long delays. ED staff reported they rarely saw the executive team.” Professor Cooke also warned of uncertainty over escalation processes, including for reducing pressure in the emergency department by “boarding” patients on wards beyond normal capacity. He said: “On the second morning, there were multiple patients on oxygen in ordinary seats in majors waiting room, cared for by a single nurse. I find it difficult to understand how this is safer than boarding one extra patient on several wards.” “Staff perceived that the organisation was reluctant to move to higher escalation levels and I sensed this meant staff no longer pushed for such actions.” Read full story (paywalled) Source: HSJ, 23 March 2023 -
News Article
Self-harm hospital admissions up 22% for children aged eight to 17
Patient Safety Learning posted a news article in News
Self-harm hospital admissions for children aged eight to 17 in the UK jumped 22% in one year. The age group is now the largest for self-harm admissions, with all others seeing a drop, according to NHS data. Charities say early access to support is vital, but high thresholds and long waiting lists mean more young people are ending up in hospital. Emily Nuttal, 29, first struggled with self-harm when she was 12. At 13, she was first admitted to A&E. At that time, she was struggling with changes at school, bullying and troubles at home. Over the years, she said she had had varied experiences in accident and emergency departments. "It's been times where it's been really empathetic and passionate people, understanding, supportive. And there's been times where there's been that stigma and judgement." She said being labelled as "attention-seeking" was really difficult and made it harder to reach out for help again. "I would then only go if I was forced upon by the crisis service, or if somebody else noticed, and they got people involved," she said. Read full story Source: BBC News, 23 March 2023 -
News Article
NHS warned ‘cramming’ A&Es with medics is not working
Patient Safety Learning posted a news article in News
The NHS’s efforts to prop up emergency departments with thousands of additional medical staff has been the wrong approach to solving the crisis in these services, experts have argued. Analysis of NHS staffing data by HSJ shows the emergency care medical workforce has grown by almost two-thirds since 2016, far outstripping the growth in other specialties. Despite this, waiting times in accident and emergency have deteriorated significantly over the same period. John Appleby, chief economist at the Nuffield Trust think tank, said: “Cramming the A&E department with more doctors doesn’t look like it’s having the intended effect over the last four to five years. Waiting times have got worse and we have more staff. “Increasing staffing has helped with waiting times in the past, but maybe we have reached a point where it’s not staffing in A&E which is the issue. The issue is the front door and the backdoor of the A&E.” Read full story (paywalled) Source: HSJ, 17 March 2023 -
Content ArticleA BBC Newsnight investigation hears devastating evidence and testimony of ambulance failings in the north east of England. What does it take to run a safe service that patients can trust?
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Content Article
Age UK: Fixing the Foundations (17 February 2023)
Patient Safety Learning posted an article in Older people
A new in-depth report from the Charity Age UK, ‘Fixing the Foundations’, reveals how our under-funded and overstretched NHS and social care system is struggling and sometimes failing to cope with the needs of older people. The report provides a first-hand account of older people’s difficulties in getting the good, joined up health and social care they need to manage at home, leaving them at risk of crisis which often results in being admitted to hospital. Yet the evidence is clear that with the right care at the right time many of these admissions could have been avoided. The report also includes perspectives from professionals and unpaid carers. It also shows how living with multiple long-term health conditions, as a significant proportion of older people do, including more than two-thirds of those aged over 85, makes it especially hard to navigate health services which are still usually organised around individual illnesses and diseases. Meanwhile social care was often inadequate or absent in these older people’s lives. Age UK estimates that astonishingly, over 1.6 million older people have some level of fundamental care and support need, such as help to get dressed, washed or getting out of bed, that is not being fully addressed. -
Content ArticleQuality improvement is a methodology used routinely in emergency departments (EDs) to bring about change to improve outcomes such as waiting times, time to treatment and patient safety. However, introducing the changes needed to transform the system in this way is seldom straightforward with the risk of “not seeing the forest for the trees” when attempting to make changes. This article in Annals of Emergency Medicine aims to demonstrate how the functional resonance analysis method can be used to capture the experiences and perceptions of frontline staff to identify the key functions in the system (the trees), to understand the interactions and dependencies between them to make up the ED ecosystem (“the forest”) and to support quality improvement planning, identifying priorities and patient safety risks.
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Content ArticleNHS trusts have often reported emergency department doctors having low levels of satisfaction and high rates of burnout, leading to a high turnover. In 2017, Brighton and Sussex University Hospitals (BSUH) and Western Sussex Hospitals merged to form University Hospitals Sussex NHS Foundation Trust. The Trust found that the organisation of shifts at Royal Sussex County Hospital (RSCH) and Princess Royal Hospital (PRH) and lack of flexibility were adding to the strain already felt by doctors working in the high pressure emergency department. To combat the pressure consultants and other doctors were under, the Trust implemented a system to help improve rota design and flexible working. The hope was that the system would help the trust retain and recruit staff, whilst saving locum costs and improving patient care.
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Content ArticleThese prompt cards were developed by a team at University Hospitals Sussex NHS Foundation Trust to assist emergency department teams in dealing with: medical emergencies trauma transfers and briefings anaesthetics and resuscitation procedures medications clinical scores.
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Content Article
The Psychologically informed policy and practice development (PIPP) project investigated current workplace concerns, barriers to change and opportunities for development and growth, and was a collaborative project run by the Royal College of Emergency Medicine, UK Research and Innovation and the University of Bath. This document details specific evidence-based recommendations relating to four key areas identified as prioritised targets in emergency care workforce development: An environment to thrive in Cultivating a better culture A tailored pathway of care Enhanced leadership The recommendations are detailed, supported by evidence, existing guidelines and new empirical data, and are specific to the needs of the emergency care specialty. -
Content ArticleTo support recovery of the NHS by improving waiting times and patient experience, a joint Department of Health and Social Care (DHSC) and NHS England plan sets out a number of ambitions, including: Patients being seen more quickly in emergency departments: with the ambition to improve to 76% of patients being admitted, transferred or discharged within four hours by March 2024, with further improvement in 2024/25. Ambulances getting to patients quicker: with improved ambulance response times for Category 2 incidents to 30 minutes on average over 2023/24, with further improvement in 2024/25 towards pre-pandemic levels. NHS England has engaged with a wide range of stakeholders to develop the plan, and it draws on a diverse range of opinion and experience, as well as views of patients and users. The Department of Health and Social Care, who produced the content on actions being taken in social care, have led on engagement with the sector.
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Content ArticleThe Royal College of Emergency Medicine (RCEM) ‘Wales' Emergency Medicine Workforce Census 2023’ is an in-depth analysis of the state of the Emergency Medicine workforce, providing an insight into the working patterns of clinicians and allowing a forecast to be made around the future workforce needs of Emergency Departments in Wales.
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Content ArticleThis article in The Times explains why the Times Health Commission was set up, what it aims to achieve and how it will do this. The year-long commission aims to address the most urgent challenges facing health and social care including the growing pressure on budgets, the A&E crisis, rising waiting lists, health inequalities, obesity and the ageing population. Commissioners will draw up recommendations in ten areas to identify problems and find solutions. The Commission will publish its final report in January 2024.
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Content ArticleEmergency access to healthcare is in crisis. Unmet need in primary and community care and low capacity in hospitals and social care has left the emergency health services gridlocked and overwhelmed, unable to provide safe care. This Cross party House of Lords Public Services Committee report recommends that a COBR Committee be assigned the responsibility to address the crisis in emergency healthcare. In the long-term, it recommends a a substantial overhaul is needed, one which sets out a bold new operating model for the system as a whole, and which is backed by equally bold leadership.
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Content ArticleIn this post, Amber Clour, author of the Diabetes Daily Grind blog, talks about her experience of managing her type 1 diabetes while attending the emergency room for suspected appendicitis. She describes the steps she took to make sure her blood sugar levels were managed safely and with her consent, including communicating clearly with all healthcare professionals, ensuring her continuous glucose monitor (CGM) was not removed and bringing her own supply of glucose tablets to manage hypoglycaemia. Further reading Blog - “I felt lucky to get out alive”: why we must improve hospital safety for people with diabetes
